Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network

This study sought to investigate the following research questions: Are time-limited day treatment programs for patients with personality disorder (PD) effective outside resourceful university settings, and what are the overall treatment results when the program is implemented on a larger scale? Do all categories and subtypes of PDs respond favorably to such treatment? How intensive should such day treatment programs be? All patients (n = 1,244) were consecutively admitted to eight different treatment programs in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2000. Altogether, 1,010 patients were diagnosed with PD. Avoidant, borderline, not otherwise specified (NOS), and paranoid PD were the most common conditions. SCID-II and MINI were used as diagnostic instruments. Outcome measures included GAF Global Assessment of Functioning, (GAF; American Psychiatric Association, 1994), SCL-90R, CIP, Quality of Life, work functioning and parasuicidal behavior, measured at admittance, discharge and 1-year follow up. The attrition rate was 24%. The number of dropouts did not improve over time. As a group, completers with PD improved significantly on all outcome variables from admittance to discharge and improvement was maintained or increased at follow up. Treatment results were best for borderline PD, cluster C patients, PD NOS and No PD, and poorer for cluster A patients. Units with a high treatment dosage did not experience better outcomes than those with a low treatment dosage (10 hours per week). Results from the University unit were not better than those from units at local hospitals or mental health centers.     

Covariation detection in treated and untreated spider phobics.

Twenty treated and 18 untreated spider phobics were exposed to a series of 72 slides. Three different categories of slides were used: phobia-relevant slides (spiders), alternative fear-relevant slides (weapons), and neutral slides (flowers). Slides were randomly paired with either a shock, a tone, or nothing at all. Despite the absence of a systematic correlation between slides and outcomes, untreated phobics strongly overestimated the covariation between spider slides and shock. Treated phobics did not show a covariation bias, suggesting that such bias can be modulated by behavioral treatment. In addition, untreated subjects were more confident about their contingency estimates than were treated subjects. The present results fit with earlier studies.     

Individual differences in spatial configuration learning predict the occurrence of intrusive memories

The dual-representation model of posttraumatic stress disorder (PTSD; Brewin, Gregory, Lipton, & Burgess, Psychological Review, 117, 210-232 2010) argues that intrusions occur when people fail to construct context-based representations during adverse experiences. The present study tested a specific prediction flowing from this model. In particular, we investigated whether the efficiency of temporal-lobe-based spatial configuration learning would account for individual differences in intrusive experiences and physiological reactivity in the laboratory. Participants (N = 82) completed the contextual cuing paradigm, which assesses spatial configuration learning that is believed to depend on associative encoding in the parahippocampus. They were then shown a trauma film. Afterward, startle responses were quantified during presentation of trauma reminder pictures versus unrelated neutral and emotional pictures. PTSD symptoms were recorded in the week following participation. Better configuration learning performance was associated with fewer perceptual intrusions, r = ?.33, p < .01, but was unrelated to physiological responses to trauma reminder images (ps > .46) and had no direct effect on intrusion-related distress and overall PTSD symptoms, rs > ?.12, ps > .29. However, configuration learning performance tended to be associated with reduced physiological responses to unrelated negative images, r = ?.20, p = .07. Thus, while spatial configuration learning appears to be unrelated to affective responding to trauma reminders, our overall findings support the idea that the context-based memory system helps to reduce intrusions.     

Boundary distortions for neutral and emotional pictures

In two experiments, we examined Safer, Christianson, Autry, and Osterlund's (1998) claim that when emotional material is remembered, tunnel memory (i.e., the tendency to remember less of a scene than was actually shown) occurs. In Experiment 1, 81 undergraduate students drew photographs from memory after having briefly seen either four neutral or four emotional photographs. Both neutral and emotional drawings revealed boundary extension (i.e., the tendency to remember more of a scene than was actually shown). Experiment 2 relied on the camera distance paradigm (Intraub, Bender, & Mangels, 1992). In a recognition test, 60 undergraduate students judged the camera distance of previously seen neutral or emotional photographs. The majority of them demonstrated accurate judgments and neither extended nor restricted picture boundaries. Those participants who made an error more often displayed a boundary extension than a tunnel memory error. Taken together, our results suggest that boundary extension for neutral and emotional photographs is a more robust phenomenon than its counterpart, tunnel memory.     

Adaptive memory: Stereotype activation is not enough

Studies have shown that survival processing leads to superior memorability. The aim of the present study was to examine whether this survival recall advantage might result from stereotype activation. To test this hypothesis, we conducted a pilot study and two experiments in which participants were primed with stereotypes (Experiment 1, professor and elderly person; Experiment 2, survival-stereotype). In Experiment 1, 120 undergraduates were randomly assigned to a survival, professor stereotype, elderly person stereotype, or moving scenario and rated words for their relevance to the imagined scenario. In Experiment 2, 75 undergraduates were given a survival, survival-stereotype (based on our pilot study), or moving scenario. Both experiments showed that survival processing leads to a greater recall advantage over the stereotype groups and control group. These data indicate that the mere activation of stereotypes cannot explain the survival recall advantage.     

Dissociation and memory suppression: A comparison of high and low dissociative individuals’ performance on the Think–No Think task

The present study examined whether high and low dissociative individuals differ in their ability to keep target stimuli out of their awareness (suppression) and how this relates to their memory of those targets during a later cued recall task. The prediction was that high dissociators display a general inability to focus attention and that their distractibility undermines successful suppression, thereby enhancing memory for suppressed items. College students with high (n = 35) and low (n = 33) scores on the Dissociative Experiences Scale participated in a Dutch version of Anderson and Green’s (2001) Think–No Think (TNT) task. Overall, a significant suppression effect emerged. However, no differences between high and low dissociators were observed. Thus, the present results do not confirm that dissociation is linked to heightened distractibility.     

Lebensqualität von ärztlichen und psychologischen Psychotherapeuten

In a large empirical cross-sectional study the quality of life of medical and psychological psychotherapists ( n =71, respectively n =103) was examined as well as the influence of the different therapeutic methods used. Instruments used were the Questionnaire on Quality of Life of Physicians (Reimer and Jurkat 2003) respectively the Questionnaire on Quality of Life of Psychologists (Jurkat and Reimer 2003) as well as the SF-36 Health Survey (Bullinger and Kirchberger 1998). The majority of participants in both samples are satisfied with their life. Psychological psychotherapists are comparatively more content with their work situation and judge their own health more positively than their medical colleagues do. Both groups feel their income situation to be a loss in quality of life. A common fear is an even greater bureaucratic burden and financial deterioration. Thus it seems that psychohygienic measures and secure job perspectives may contribute to raising the quality of life of psychotherapists.